New government rules - enforcement kicked in last month - require hospices to send doctors or nurse practitioners for face-to-face visits with Medicare patients who have been on hospice more than six months to certify that the patients are really sick enough to need the program. The new rules came in response to lengthening hospice stays as services expanded beyond cancer patients to those with slower-moving and less predictable illnesses like heart failure, Alzheimer's, and chronic obstructive pulmonary disease.
Government spending on hospice grew from $2.9 billion in 2000 to $10 billion in 2007, according to a 2009 report from MedPac, the Medicare Payment Advisory Commission that recommended the tougher stance on long stays. During those years, the number of hospice providers rose from 2,300 to 3,200, with most of the growth in for-profits.
MedPac said that hospice is most profitable during long stays, which "may have led to inappropriate utilization of the benefit among some hospices." While the median length of stay has remained steady at about two weeks, the longest stays have gotten longer. The agency estimated that, in about 6 percent of hospices, 40 percent or more of stays exceed 180 days.
The longer stays, MedPac said, blur the distinction between true hospice and long-term care.
Area hospices say the new rules have forced them to hire more doctors and nurse practitioners. Because reimbursements haven't gone up, that's squeezing their budgets. Although few patients actually are dropped from hospice, the new visits also are scaring families that rely on hospice to help them with the arduous work of caring for the dying at home.
